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Introduction to Chapter 3 How the larger culture helps shape both technical knowledge and the technicians ' notions of their own identity is suggested in Alan I Marcus's essay on the shift from individual practitioner to regular physician in mid-nineteenth -century Cincinnati. Taking the history of Cincinnati medical societies as his narrative or empirical base for understanding the larger culture, Marcus probes the arcane histories of several antebellum Cincinnati medical societies. In particular Marcus finds a large cultural shift, from an age venerating the individual to one stressing the reality of group identity and membership. Thus in the early nineteenth century-to the late 1830s, that is-medical men followed a code of conduct of genteel individualism, a kind ofJeffersonian or republican elite of talent and merit in which manners , morals, and expertise were juxtaposed in the same individuals and in which communal association with one's fellows kept a doctor's behavior on the up and up. Marcus insists that the early nineteenth-century medical societies and the medical knowledge that they preserved were fully a construction of contemporary society and culture, in which the individualistic perspective reigned supreme. As each individual doctor was a free agent, he could better himself. Success was possible. It was measured in terms of what one did, rather than what one had, such as inherited status and wealth. This gave the licensed doctor an enormous competitive edge over his unlicensed colleague. Starting in the 1830s, however, Marcus insists, doctors began to define themselves in new kinds of ways and thus created a very different nexus of cultural notions, institutions, and technical discourses for the practice of medicine in American society and culture. According to this new definition, 53 54 Introduction: Chapter 3 or redefinition, doctors were not mere individuals. They belonged to distinct and different groups of medical practitioners. Each group of doctors had their own intellectual system of medicine, their own materia medica-their own medical systems. Medical systems were not codifications of genteel individualism. Rather they were sets ofcommunally shared beliefs, practices, and behaviors. Membership in a group and identification with its beliefs and practices-these were what mattered now. Thus Marcus lays bare the key to the seemingly undecipherable warring of medical sects in post-I830S America: the invention of the group rather than the individual as the key to society and culture. Technical knowledge-in this instance, knowledge about doctors , their diagnoses, their remedies, and the like-underwent dramatic shifts and transformations, in which old knowledge was reshaped into new knowledge, seemingly as the result of a shift in the culture's larger notions of how society and nature were constructed. ALAN I MARCUS From Individual Practitioner to Regular Physician: Cincinnati Medical Societies and the Problem of Definition among Mid-Nineteenth-Century Americans 3 The Medico-Chirurgical Society of Cincinnati and the Cincinnati Medical Society never fulfilled their founders' expectations. Sparsely attended, infrequently held meetings with programs members treated with indifference continually plagued the two organizations. This lack of enthusiasm indicates that to the vast majority of Cincinnati doctors, neither the Medico-Chirurgical Society, founded in 1848, nor the Medical Society, formed in 1851, seemed a useful or appropriate forum. In 1857, a group from the MedicoChirurgical Society proposed and established a new medical society, the Academy of Medicine of Cincinnati. The new society differed in structure from its predecessors. Earlier medical organizations had chosen their members quite carefully and conducted sessions in camera. The academy, on the other hand, welcomed all regular medical practitioners, threw its doors open to medical students, and regularly published its transactions in city medical journals. The academy's objectives also differed strikingly from those of earlier area medical societies. According to its first president, the venerable Reuben D. Mussey, the academy sought to make "its proceedings the basis of public opinion in matters pertaining to medicine:'! The radical departure by the Academy of Medicine from established medical society norms suggests that it was grounded on new premises. Emphasis on inclusiveness rather than selectivity, for example, implied that its founders assumed a certain homogeneity among regular physicians. Its desire to mold public opinion rather than restrict deliberations to members suggested that these founders understood that the group's status depended on public approval. Finally, their decision to publish its transactions in medical periodicals-a frank attempt to reach out to regulars unable or unwilling 55 Alan I Marcus to attend its meetings-betrayed their realization that each regular physician 's status and well...

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